Podcast
Questions and Answers
Who can refuse medical care and/or transport?
Who can refuse medical care and/or transport?
- Minor under the age of 18
- Competent adult patient (correct)
- Legal representative for the patient
- Any individual regardless of age
Under what conditions can a minor refuse medical care and/or transport?
Under what conditions can a minor refuse medical care and/or transport?
- Minor under any circumstances
- Competent emancipated minor (correct)
- Minor with parental consent
- Unaccompanied minor
Who may be considered incompetent to refuse care?
Who may be considered incompetent to refuse care?
- Person with severe medical condition affecting decision-making (correct)
- Legal representative for the patient
- Any individual refusing care
- Any minor under the age of 18
What is the primary purpose of the refusal of care procedure?
What is the primary purpose of the refusal of care procedure?
Who can accept responsibility on behalf of a parent for refusing medical care for a minor?
Who can accept responsibility on behalf of a parent for refusing medical care for a minor?
Under what conditions can diabetic patients sign a Patient Refusal Form?
Under what conditions can diabetic patients sign a Patient Refusal Form?
Who is responsible for medical direction at the destination facility or the agency?
Who is responsible for medical direction at the destination facility or the agency?
Under what circumstances should high-risk refusals require consultation with medical direction?
Under what circumstances should high-risk refusals require consultation with medical direction?
What should be determined before refusal of care for a single patient?
What should be determined before refusal of care for a single patient?
What should be provided to the patient after they sign the 'Refusal of Care' form?
What should be provided to the patient after they sign the 'Refusal of Care' form?
What is the purpose of the Health and Safety committee developed by the Fire Chief’s Association of Broward County (FCABC)?
What is the purpose of the Health and Safety committee developed by the Fire Chief’s Association of Broward County (FCABC)?
Which organization has recognized BHAP as a world standard of care for first responders?
Which organization has recognized BHAP as a world standard of care for first responders?
What types of incidents are referred to as Debilitating Critical Incidents (DCI) for BHAP response?
What types of incidents are referred to as Debilitating Critical Incidents (DCI) for BHAP response?
What should be done if the patient or responsible party will not sign the release?
What should be done if the patient or responsible party will not sign the release?
What is the purpose of BHAP?
What is the purpose of BHAP?
What should be done if possible when dealing with patients?
What should be done if possible when dealing with patients?
Name one organization that has embraced the BHAP model according to the text.
Name one organization that has embraced the BHAP model according to the text.
What should be done after a 'Refusal of Care' form is signed?
What should be done after a 'Refusal of Care' form is signed?
When is small group defusing recommended after a critical incident?
When is small group defusing recommended after a critical incident?
When is small group debriefing recommended after a critical incident?
When is small group debriefing recommended after a critical incident?
What is the primary focus of Crisis Management briefing?
What is the primary focus of Crisis Management briefing?
What does Florida Statute 401.30(4) (e) protect during a CISM intervention?
What does Florida Statute 401.30(4) (e) protect during a CISM intervention?
What is the primary role of the Peer Support program for first responders?
What is the primary role of the Peer Support program for first responders?
What is the main responsibility of the Chaplain in the BHAP activation process?
What is the main responsibility of the Chaplain in the BHAP activation process?
What do Evaluated Recovery Centers provide for first responders?
What do Evaluated Recovery Centers provide for first responders?
What is the goal of Family Support programs for first responders' families?
What is the goal of Family Support programs for first responders' families?
What is a key requirement for effective insurance coverage for first responders?
What is a key requirement for effective insurance coverage for first responders?
What is one of the responsibilities of Trained Clinician Response Team (CRT) for first responders?
What is one of the responsibilities of Trained Clinician Response Team (CRT) for first responders?
What is one way Retiree Support Programs can benefit retired first responders?
What is one way Retiree Support Programs can benefit retired first responders?
What should be provided by Employee Assistance Programs for first responders?
What should be provided by Employee Assistance Programs for first responders?
Who should be notified to initiate a BHAP Team response?
Who should be notified to initiate a BHAP Team response?
What information does the duty officer provide when activating the CISM?
What information does the duty officer provide when activating the CISM?
Who receives the information and informs the BHAP Clinical Director of the incident?
Who receives the information and informs the BHAP Clinical Director of the incident?
What dictates the type of response by the BHAP Team Coordinator?
What dictates the type of response by the BHAP Team Coordinator?
What is the color of the paper on which the Do Not Resuscitate Order (DNRO) form should be printed?
What is the color of the paper on which the Do Not Resuscitate Order (DNRO) form should be printed?
Who must sign the Do Not Resuscitate Order (DNRO) form and patient identification device to make them valid?
Who must sign the Do Not Resuscitate Order (DNRO) form and patient identification device to make them valid?
What is the only approved form for a Do Not Resuscitate Order (DNRO) in the State of Florida?
What is the only approved form for a Do Not Resuscitate Order (DNRO) in the State of Florida?
What is the purpose of the patient identification device that is part of the Do Not Resuscitate Order (DNRO) form?
What is the purpose of the patient identification device that is part of the Do Not Resuscitate Order (DNRO) form?
What action should EMS take upon presentation of a completed Florida Do Not Resuscitate Order Form (DH Form 1896)?
What action should EMS take upon presentation of a completed Florida Do Not Resuscitate Order Form (DH Form 1896)?
What should be done if there is a DNRO/POLST/MOST/MOLST form from another State presented by the patient or family?
What should be done if there is a DNRO/POLST/MOST/MOLST form from another State presented by the patient or family?
What color should be used for duplicating DH Form 1896 for Do Not Resuscitate Order (DNRO)?
What color should be used for duplicating DH Form 1896 for Do Not Resuscitate Order (DNRO)?
What is required for a Do Not Resuscitate Order (DNRO) form to be valid?
What is required for a Do Not Resuscitate Order (DNRO) form to be valid?
What should be done if the patient's clothing has a puncture?
What should be done if the patient's clothing has a puncture?
What should be done with removed clothing?
What should be done with removed clothing?
What should be done if the patient relates any information relating to the crime while in transit to the medical facility?
What should be done if the patient relates any information relating to the crime while in transit to the medical facility?
What should NOT be done with any object at the scene or after leaving the crime scene?
What should NOT be done with any object at the scene or after leaving the crime scene?
Who can revoke a Do Not Resuscitate Order (DNRO) according to the text?
Who can revoke a Do Not Resuscitate Order (DNRO) according to the text?
What information must be documented in the EMS Run Report if a witness is used to identify the patient for the DNRO form?
What information must be documented in the EMS Run Report if a witness is used to identify the patient for the DNRO form?
What care should the EMS provider provide during transport of a patient with a DNRO form?
What care should the EMS provider provide during transport of a patient with a DNRO form?
How can a Do Not Resuscitate Order (DNRO) be revoked according to Section 765.104, F.S.?
How can a Do Not Resuscitate Order (DNRO) be revoked according to Section 765.104, F.S.?
What does POLST stand for in the context of EMS protocols and end-of-life planning?
What does POLST stand for in the context of EMS protocols and end-of-life planning?
What is the primary emphasis of POLST in end-of-life care?
What is the primary emphasis of POLST in end-of-life care?
In which situations are EMS guidelines for determining death applicable?
In which situations are EMS guidelines for determining death applicable?
Which form ensures that patient wishes are honored and reduces medical errors in end-of-life care?
Which form ensures that patient wishes are honored and reduces medical errors in end-of-life care?
Under what conditions may EMS request entry into a crime scene?
Under what conditions may EMS request entry into a crime scene?
What is the primary purpose of the POLST form in end-of-life care?
What is the primary purpose of the POLST form in end-of-life care?
What is emphasized in the POLST paradigm?
What is emphasized in the POLST paradigm?
Who are POLST forms intended for?
Who are POLST forms intended for?
Who is responsible for modifying the assignment for an Air Rescue response?
Who is responsible for modifying the assignment for an Air Rescue response?
In which situation may Air Rescue response be necessary?
In which situation may Air Rescue response be necessary?
Who should be dispatched for an Air Rescue assignment as per standard procedure?
Who should be dispatched for an Air Rescue assignment as per standard procedure?
When may additional units be needed for an Air Rescue assignment?
When may additional units be needed for an Air Rescue assignment?
What is a key consideration for requesting Air Rescue for patient transport?
What is a key consideration for requesting Air Rescue for patient transport?
What information must on-scene personnel communicate to Air Rescue as quickly as possible?
What information must on-scene personnel communicate to Air Rescue as quickly as possible?
What is a requirement for the landing zone for Air Rescue?
What is a requirement for the landing zone for Air Rescue?
How should a patient be prepared for transport by Air Rescue?
How should a patient be prepared for transport by Air Rescue?
What should personnel do upon Air Rescue's arrival on scene?
What should personnel do upon Air Rescue's arrival on scene?
What should be done with sheets, blankets, and IV poles before approaching the helicopter?
What should be done with sheets, blankets, and IV poles before approaching the helicopter?
What should ground crews announce if a hazard is identified during the helicopter's final approach to the landing zone?
What should ground crews announce if a hazard is identified during the helicopter's final approach to the landing zone?
Who must ensure that no bystanders approach the aircraft during landing, patient loading, and take-off?
Who must ensure that no bystanders approach the aircraft during landing, patient loading, and take-off?
What is not necessary to have at a landing zone for Air Rescue?
What is not necessary to have at a landing zone for Air Rescue?
What should personnel inform the patient about before loading them onto a helicopter for transport?
What should personnel inform the patient about before loading them onto a helicopter for transport?
What is the purpose of the Mass Casualty Incident protocol?
What is the purpose of the Mass Casualty Incident protocol?
How is an Active Assailant different from an Active Shooter?
How is an Active Assailant different from an Active Shooter?
What does ASHER stand for in the context of mass casualty incidents?
What does ASHER stand for in the context of mass casualty incidents?
When is the Mass Casualty Incident protocol applicable?
When is the Mass Casualty Incident protocol applicable?
What is the purpose of the Rescue Task Force?
What is the purpose of the Rescue Task Force?
How are victims prioritized during triage?
How are victims prioritized during triage?
What should be done with the 'walking wounded' at the incident site?
What should be done with the 'walking wounded' at the incident site?
Who may be designated as officers as additional units arrive?
Who may be designated as officers as additional units arrive?
How are Mass Casualty Incidents classified?
How are Mass Casualty Incidents classified?
What should Command do if an MCI response needs to be adjusted?
What should Command do if an MCI response needs to be adjusted?
Under what circumstances should trauma transport criteria be reported to a trauma center?
Under what circumstances should trauma transport criteria be reported to a trauma center?
What should be considered when announcing an MCI?
What should be considered when announcing an MCI?
What is the primary purpose of Ballistic Protection Equipment (BPE)?
What is the primary purpose of Ballistic Protection Equipment (BPE)?
What is the function of a Casualty Collection Point (CCP)?
What is the function of a Casualty Collection Point (CCP)?
What does Unified Command (UC) involve?
What does Unified Command (UC) involve?
What is the responsibility of a Contact Team/Law Enforcement Entry Team?
What is the responsibility of a Contact Team/Law Enforcement Entry Team?
What do Zones at Active Shooter Hostile Events designate?
What do Zones at Active Shooter Hostile Events designate?
What is the recommended response for an MCI Level 1 (5-10 victims)?
What is the recommended response for an MCI Level 1 (5-10 victims)?
In an MCI Level 2 (11-20 victims), how many EMS Shift Supervisors are recommended?
In an MCI Level 2 (11-20 victims), how many EMS Shift Supervisors are recommended?
What is the responsibility of Medical Control (Medcom/MRCC) upon notification of an MCI?
What is the responsibility of Medical Control (Medcom/MRCC) upon notification of an MCI?
What should be considered on a large-scale incident according to the text?
What should be considered on a large-scale incident according to the text?
Who is responsible for maintaining communication with Medical Control to assure proper victim transport information and destination?
Who is responsible for maintaining communication with Medical Control to assure proper victim transport information and destination?
What is the responsibility of the Medical Supply Coordinator?
What is the responsibility of the Medical Supply Coordinator?
Who is responsible for managing all activities within the staging area?
Who is responsible for managing all activities within the staging area?
What should the Medical Communication Coordinator relay to Medical Control when units are prepared to transport victims?
What should the Medical Communication Coordinator relay to Medical Control when units are prepared to transport victims?
Who determines the most appropriate facility for victim transport in conjunction with Medical Control?
Who determines the most appropriate facility for victim transport in conjunction with Medical Control?
What does the Staging Officer coordinate with the Transport Officer?
What does the Staging Officer coordinate with the Transport Officer?
What is the responsibility of the Medical Supply Coordinator in relation to equipment on transporting vehicles?
What is the responsibility of the Medical Supply Coordinator in relation to equipment on transporting vehicles?
Who is responsible for maintaining a Hospital Transportation Log #5B?
Who is responsible for maintaining a Hospital Transportation Log #5B?
What is the responsibility of the Triage Officer in a mass casualty incident?
What is the responsibility of the Triage Officer in a mass casualty incident?
In an MCI Level 4, how many Mass Transit Buses are required?
In an MCI Level 4, how many Mass Transit Buses are required?
What is the primary responsibility of Medical Branch officers in a mass casualty incident?
What is the primary responsibility of Medical Branch officers in a mass casualty incident?
How many MCI Task Forces are required in an MCI Level 5?
How many MCI Task Forces are required in an MCI Level 5?
What do officers involved in a mass casualty incident NOT have the responsibility of doing?
What do officers involved in a mass casualty incident NOT have the responsibility of doing?
How many ALS Transport Units are required in an MCI Level 3?
How many ALS Transport Units are required in an MCI Level 3?
What is the primary responsibility of the Transport Officer in a mass casualty incident?
What is the primary responsibility of the Transport Officer in a mass casualty incident?
What is NOT required in an MCI Level 5?
What is NOT required in an MCI Level 5?
What is NOT part of the responsibilities for officers involved in a mass casualty incident?
What is NOT part of the responsibilities for officers involved in a mass casualty incident?
How many Suppression Unit Strike Teams are required in an MCI Level 4?
How many Suppression Unit Strike Teams are required in an MCI Level 4?
What is included in the MCI Kits for Responder Vehicles?
What is included in the MCI Kits for Responder Vehicles?
How many triage tags are included in the MCI Kits?
How many triage tags are included in the MCI Kits?
What is included in the MCI FOGs, logs, and associated paperwork for each officer?
What is included in the MCI FOGs, logs, and associated paperwork for each officer?
In the START triage method, what color is assigned to a victim with no respiration after a head tilt?
In the START triage method, what color is assigned to a victim with no respiration after a head tilt?
What is the color assigned to a victim with respirations over 30/min or respiratory distress in the START triage method?
What is the color assigned to a victim with respirations over 30/min or respiratory distress in the START triage method?
For infants who are developmentally unable to walk, which triage algorithm should be used according to the text?
For infants who are developmentally unable to walk, which triage algorithm should be used according to the text?
Who developed the START Triage system according to the text?
Who developed the START Triage system according to the text?
In the JumpSTART Triage system, what color is assigned to a victim with no respiration after head tilt and no peripheral pulse?
In the JumpSTART Triage system, what color is assigned to a victim with no respiration after head tilt and no peripheral pulse?
What is the color assigned to a victim with stable RPM/walking in the JumpSTART Triage system?
What is the color assigned to a victim with stable RPM/walking in the JumpSTART Triage system?
What physiological differences in children necessitate adaptation of the standard START triage method according to the text?
What physiological differences in children necessitate adaptation of the standard START triage method according to the text?
What adaptation is indicated for children 8 years of age or younger or those victims with anatomical or physiological features of a child in the age group?
What adaptation is indicated for children 8 years of age or younger or those victims with anatomical or physiological features of a child in the age group?
Study Notes
Refusal of Medical Care and Transport Guidelines
- Guidelines specify that individuals may not refuse medical care or transport under certain conditions, including altered consciousness, suicidal behavior, severely altered vital signs, mental disability, intoxication, and being younger than 18.
- If a parent or guardian of a minor with traumatic injuries cannot make it to the scene, they may request by phone that their child not be transported to the hospital.
- An adult present and willing to sign the patient refusal form can accept responsibility on behalf of the parent, with verbal consent, and leave the child in their care.
- These interactions should be well-documented in the electronic patient care report (ePCR).
- Patients who refuse to be transported to the closest appropriate facility and insist on being transported elsewhere should be considered to be refusing transport.
- Implied consent may be used for treating and transporting incompetent individuals.
- The physician at the destination facility or the agency’s Medical Director is responsible for medical direction.
- High-risk refusals, such as those involving minors, refusal of care representing significant risk, or refusal after administration of IV medication, require consultation with medical direction.
- Diabetic patients may sign a Patient Refusal Form under specific conditions, including lucidity, acceptable blood glucose levels, immediate access to food, and meeting refusal criteria.
- The procedure does not allow for more than one refusal on a single EMS Run Report, but individuals who refuse ALL assistance can be combined on a single report.
- All measures should be taken to convince the patient to consent, including enlisting the help of family or friends.
- For a single patient, mental status, extent and history of injury, and physical assessment should be determined before refusal of care.
EMS Protocols and End-of-Life Planning
- Nonphysician staff or absent physician orders are not acceptable for EMS decisions
- Florida will adopt the POLST (Physician Orders for Life Sustaining Treatment Paradigm)
- POLST emphasizes patient wishes, advance care planning, and shared decision-making
- POLST form ensures patient wishes are honored and reduces medical errors
- POLST is for patients with serious illness or frailty, not healthy patients
- Several states use POLST, MOLST, MOST, and POST forms for end-of-life care
- EMS guidelines for determining death include conditions like lividity and rigor mortis
- Special considerations for trauma victims and patients with penetrating or blunt chest trauma
- Law enforcement involvement in crime scenes and EMS response protocols
- EMS may request entry into a crime scene to determine the patient's life status
- Minimum EMS personnel should enter a crime scene to minimize disturbance
- Protocols for resuscitation and treatment in crime scene situations
Mass Casualty Incident and Active Shooter Hostile Events Response Procedures
- Ballistic Protection Equipment (BPE) is personal protective equipment (PPE) to protect against ballistic threats, stabbing, fragmentation, or blunt force trauma.
- Casualty Collection Point (CCP) is a temporary location for gathering, triage, and medical stabilization of casualties.
- Complex Coordinated Attack involves multiple asymmetric attack modes and coordinated attacks on multiple locations.
- Concealment refers to protection from observation, providing or not providing protection from the threat.
- Contact Team/Law Enforcement Entry Team is a team of officers tasked with locating and neutralizing the threat.
- Cover provides protection from firearms or hostile weapons.
- Rescue Task Force (RTF) is a combination of fire, EMS, and law enforcement personnel providing force protection and victim extraction.
- THREAT is an acronym highlighting the importance of initial actions to control hemorrhaging.
- Unified Command (UC) is an authority structure shared by individuals from all responding organizations.
- Zones at Active Shooter Hostile Events include Hot Zone, Warm Zone, and Cold Zone, each designated based on safety and hazard levels.
- The first-arriving unit at a mass casualty incident will establish Command, perform a size-up, request response levels, and establish a staging area.
- In case of an active shooter/assailant incident, Unified Command with Law Enforcement should be established, and liaisons for Fire Department and Law Enforcement can interact to transfer information between agencies.
Mass Casualty Incident Response Structure
- MCI Level 3 involves 21-100 victims and requires 8 ALS Transport Units, 4 Suppression Units, 3 Shift Supervisors, and a Command Vehicle.
- MCI Level 4, for 101-1000 victims, necessitates 5 MCI Task Forces, 2 ALS Transport Strike Teams, 1 Suppression Unit Strike Team, 2 BLS Transport Strike Teams, and 2 Mass Transit Buses.
- MCI Level 5, for more than 1000 victims, requires 10 MCI Task Forces, 4 ALS Transport Strike Teams, 2 Suppression Unit Strike Teams, 4 BLS Transport Strike Teams, and 4 Mass Transit Buses.
- The responsibilities for officers involved in a mass casualty incident include establishing command, determining MCI level, designating staging areas, and ensuring proper security and traffic control.
- Medical Branch officers are responsible for coordinating with Command, supervising on-scene personnel, and ensuring notification of Medical Control.
- The Triage Officer is responsible for organizing and prioritizing victims based on the severity of their injuries.
- The Treatment Officer is responsible for overseeing the medical treatment of victims and ensuring the proper allocation of resources.
- The Transport Officer supervises the coordination of victims and maintains records relating to victim identification, injuries, mode of transportation, and destination.
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Description
Test your knowledge about the refusal of care procedure and the proper evaluation, treatment, and transportation of patients. Learn about situations in which a patient refuses evaluation, treatment, and/or transportation to a medical facility.
